Provider Demographics
NPI:1265098719
Name:SSV PHARMACY 1 LLC
Entity type:Organization
Organization Name:SSV PHARMACY 1 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SANDHYA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KANTAMANENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-522-9289
Mailing Address - Street 1:500 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-3106
Mailing Address - Country:US
Mailing Address - Phone:860-522-9289
Mailing Address - Fax:860-231-7007
Practice Address - Street 1:500 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-3106
Practice Address - Country:US
Practice Address - Phone:860-522-9289
Practice Address - Fax:860-231-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy